Research Abstract: Sudden Onset of Daytime Sleepiness

[Guest guest]

Greetings!

The following abstract is from a report titled:

Excessive daytime sleepiness and sudden-onset

sleep in Parkinson disease: a survey by the

Canadian Movement Disorders Group.

The link to the abstract is:

http://www.websciences.org/cftemplate/NAPS/indiv.cfm?ID=20005615

Conclusion: Not only is reaction time an issue, but sudden daytime

sleepiness is not a good thing when driving.

I've had this happen (but not when driving). It is alarming to be suddenly

overwhelmed by sleepiness. When it happens, I MUST get some rest.

Regards,

=jbf=

B. Fisher

JAMA 2002;287(4):455-63.

Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: a

survey by the Canadian Movement Disorders Group.

HOBSON DE, LANG AE, MARTIN WR, RAZMY A, RIVEST J, FLEMING J.

Department of Medicine, University of Maitoba, Winnipeg.

dhobson@...

CONTEXT: Somnolence is a recognized adverse effect of dopamine agonists. Two

new dopamine agonists, pramipexole and ropinirole, have been reported to

cause sudden-onset sleep spells in patients with Parkinson disease (PD)

while they were driving. The frequency of these spells and whether driving

should be restricted has yet to be established. OBJECTIVE: To determine the

frequency of and predictors for sudden-onset sleep and, particularly,

episodes of falling asleep while driving among patients with PD. DESIGN,

SETTING, AND PARTICIPANTS: Prospective survey conducted between January and

April 2000 in 18 clinics directed by members of the Canadian Movement

Disorders Group; 638 consecutive highly functional PD patients without

dementia were enrolled, of whom 420 were currently drivers. MAIN OUTCOME

MEASURES: Excessive daytime sleepiness and sudden-onset sleep as assessed by

the Epworth Sleepiness Scale and the Inappropriate Sleep Composite Score.

The latter score, designed for this study, addressed falling asleep in

unusual circumstances. The 2 scales were combined in 3 separate formats:

dozing off, sudden unexpected sleep, and sudden blank spells. RESULTS:

Excessive daytime sleepiness was present overall in 327 (51%) of the 638

patients and in 213 (51%) of the 420 drivers. Patients taking a variety of

different dopamine agonists had no differences in Epworth sleepiness scores,

in the composite score, or in the risk of falling asleep while driving.

Sixteen patients (3.8%) had experienced at least 1 episode of sudden onset

of sleep while driving (after the diagnosis of PD); in 3 (0.7%), it occurred

without warning. The 2 risk factors associated with falling asleep at the

wheel were the Epworth Sleepiness Scale score (odds ratio [OR], 1.14; 95%

confidence interval [CI], 1.06-1.24) and the Inappropriate Sleep Composite

Score (OR, 2.54; 95% CI, 1.76-3.66). A standard Epworth Sleepiness Scale

score of 7 or higher predicted 75% of episodes of sleep behind the wheel at

a specificity of 50% (exclusion of the question related to driving provided

70% sensitivity and 52% specificity), whereas a score of 1 on the

Inappropriate Sleep Composite Score generated a sensitivity of 52% and

specificity of 82%. CONCLUSIONS: Excessive daytime sleepiness is common even

in patients with PD who are independent and do not have dementia.

Sudden-onset sleep without warning is infrequent. The Epworth score has

adequate sensitivity for predicting prior episodes of falling asleep while

driving and its specificity can be increased by use of the Inappropriate

Sleep Composite Score. It is unknown if routinely performing these

assessments could be more effective in predicting future risk for these rare

sleep attacks. Patients should be warned not to drive if they doze in

unusual circumstances.